Online Payment System

360 Medical Billing is a professional billing service for multiple medical professionals. Any payments you make with your credit card on this secure site will appear on your credit card statement as paid to: MJCA-Emergency Physician Billing.

Thank you for choosing 360 Medical Billing Solutions. Please complete and submit the form below to make payments on your account.

* Required Field

  1. Patient Information
  2. . *
  3. *
  4. *
  5. *
  6. * (mm/dd/yyyy)
  7. *
  8. *
  9. *
  10. *
  11. *
  12. * (address@example.com)
  13. Billing Information
  14. Check this Box if Billing Information is SAME as Patient Information.
  15. *
  16. *
  17. *
  18. *
  19. *
  20. *
  21. Credit Card Information
  22. * (As it appears on Credit Card)
  23. *
  24. * (Without spaces)
  25. *    *
  26. $*


3141 NW 63rd, Oklahoma City, OK 73116
P (405) 607-1321  •  Toll free (866) 247-3141  •  F (405) 607-1326
Email  •  360MedicalBillingServices.com

© Copyright 2011, 360 Medical Billing Solutions. All Rights Reserved.  •  Online Payment System Developed & Powered by iMed Software Corporation